Government of Ontario

Important Information

• Use this form to request an authorization to carry out an inspection order under s. 33 (1) of the Fire Protection and Prevention Act, 1997.
• You must complete all sections of this form and attach additional information / documents as required. The processing of your application could be delayed if information or documents are missing.
• You have the right to a representative. If you have a representative, have them complete the Commission's Declaration of Representative form and attach it to this form.

1. Information Regarding Subject Property

Unit number
Street Number
Street Name
PO Box
City/Town/Municipality
Province   AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon
Postal Code

2. Owner's Information

Last Name
First Name
Middle Initial

3. Appellant's Contact Information

Last Name
First Name
Middle Initial
Organization

Telephone Number
Fax Number
Email Address

4. Reasons for Application

Describe in detail the reasons for your application. Attach additional pages if you require more space.

5. Acknowledgement

Read carefully; then check the below box to confirm the statement, and sign and date the form.

I have completed all pages of this form and attached all the required documentation. I understand that if I submit an incomplete form or do not attach the required documents, my appeal may not be processed.

Name

Signature

Date (yyyy/mm/dd)

The Fire Safety Commission collects the personal information requested on this form under sections 26, 33, and 36 of the Fire Protection and Prevention Act, 1997. This information is being collected for the purpose of conducting a proceeding before the FSC. Any questions about this collection may be directed to the Fire Safety Commission at 416-326-1356 or toll-free at 1-888-777-3616 or teletypewriter (TTY) at 1-800-855-0511.